The Workers Compensation Board (WCB) has scheduled the Licensed Representative Exam for Thursday, June 12, 2014 at 9:30 AM [arrival required by 8:30 AM] at the WCB office located at 328 State Street, Schenectady, New York. Depending upon the number of applicants, it may also be held at a second WCB office located at 100 Broadway, Menands, New York. Please see the Licensed Representative Examination Guide for further details.
Please keep checking this site for any further details or updates (including any updates related to date/time/location).
Applicants seeking a license to represent claimants pursuant to Section 24-a of the Workers' Compensation Law, or to become a third-party administrator (TPA) to represent self-insured employers and/or insurance carriers should complete Form OC-409 and submit it to the Licensing Office at 328 State Street, Schenectady, NY 12305-2318, along with a $100 check or money order payable to the "Chair, Workers' Compensation Board", with each application. Complete applications accompanied by the required fee are due by close of business Wednesday, April 30, 2014.
|Form Number / Version Date||Form Title||Who Files||When to File|
|Initial Application to Take License Representative Exam||This form is to be completed by individual taking exam.||Complete applications accompanied by the required fee are due by close of business Wednesday, April 30, 2014.|
Applicants seeking a license to become a third-party administrator (TPA) to represent self-insured employers and/or insurance carriers must qualify under either §50(3-b) or §50(3-d) of the Workers' Compensation Law (WCL). Section 50(3-b) permits those businesses created under the laws of New York State to apply for a license. Businesses established outside of New York may apply for a license under §50(3-d) of the WCL provided they are: (1) an insurance company duly authorized to write workers' compensation insurance in New York; (2) an affiliate or subsidiary of (1); or (3) a licensed/authorized adjusting company in New York. The corporation must submit a certificate from the New York State Insurance Department indicating one of the three criteria listed above if they choose to file under §50(3-d) of the WCL. If the corporation files under §50(3-d) of the WCL, the corporation is required to have a physical place of business and telephone number in the State of New York and must also submit documentation from NYS Department of State, indicating that they are authorized to do business in New York State.
A company or corporation applying for a TPA license must have a Qualifying Officer to represent the company or corporation. This individual is responsible for overseeing the company's conduct at Board hearings and ensuring that the laws and regulations of the Board are being followed. An individual can become a Qualifying Officer in one of two ways.
It is important to note, however, that the Qualifying Officer must be designated as an "officer" of the company (i.e., President, Vice President, Secretary, or Treasurer) that is applying to represent self-insured employers and/or carriers. A resolution appointing the Qualifying Officer as an officer of the company must be submitted with the paperwork. The specific arrangements that are made between the company and the Qualifying Officer, with respect to official duties and compensation, if any, does not need to be disclosed to the Board.
Listed below are the forms that are required to be completed:
A check or money order for $100 made payable to the "Chair, Workers' Compensation Board", should be submitted with the application. Once the application has been approved, additional money will be requested to cover the license period.
In addition to completing and submitting the above-mentioned forms, the Qualifying Officer will be required to appear before a Board Panel for an interview. Once the interview is complete, the Full Board will review the recommendation made by the Board Panel and determine if the license should be granted.
The completed forms, along with the check, should be submitted to the Workers' Compensation Board, Licensing Office, 328 State Street, Schenectady, NY 12305-2318. Please contact the Licensing Office at 1-800-664-2379 if you have any questions.